By submitting your story, you agree to the following consent document. Someone may follow up with you for more detail about your story or help amplify your story's impact. We will not share your story with identifying information without your permission.
I hereby authorize the Children's Oral Health Network of Maine (COHN), along with its licensees, successors, and assigns (collectively COHN), to republish the material I am submitting to the Story Bank (Story Bank Submission). I also consent to being interviewed, photographed, filmed, and/or audiotaped, and to the use of the Story Bank Submission and any related photographs, video, audio, and interview information (hereafter, collectively “Materials”) in any COHN materials, including but not limited to publications, presentations, websites, social media, and advertising, which COHN determines will advance its goals.
Additionally, I authorize COHN to share the Materials with other organizations, federal or state officials, media outlets, and any other individuals or organizations that COHN believes are working to further its goals.
If COHN requests my participation in an event or a one-on-one interview, COHN may contact me for permission and scheduling. However, I am under no obligation to participate in such opportunities.
I further understand and agree that I have no rights to the Materials, and that these Materials may be edited, used, published, distributed, republished, and/or licensed by COHN, now or at any time in the future, for the purposes outlined above. I waive all rights to inspect or approve the use of the Materials, now or in the future.
I understand and agree that I will not receive any monetary compensation for my participation or for the use of these Materials.
I release and discharge any and all actions or claims that I, my family members, or my heirs may have against COHN, its officers, trustees, employees, contractors, and/or agents, and any other third party contracting with COHN, arising for any reason whatsoever from any use, publication, distribution, or republication of these Materials in accordance with this Consent and Release, at any time now or in the future. I agree to defend, indemnify, and hold harmless COHN, and its employees, directors, officers, contractors, professional advisors, assignees, and agents, from and against any and all claims, demands, expenses, losses, or liabilities including, without limitation, reasonable attorney’s fees arising out of or in connection with any breach, or alleged breach, of the terms of this Agreement. This paragraph shall apply to all claims, including those arising from negligence, gross negligence, or intentional acts.
I am above 18 years of age and understand and agree to the terms set forth above for myself or on behalf of a minor for whom I am submitting.
